Difference between revisions of "Schistosomiasis"

(See Also)
(Evaluation)
 
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==Clinical Features==
 
==Clinical Features==
*Mostly a chronic condition
+
===Acute===
**Second most common cause of esophageal varicies worldwide
+
*Cutaneous [[rash]]/[[pruritus]] from cercariae penetration (immediate)
**Greatly elevated bladder cancer rates in endemic areas
+
*Katayama fever
**Can cause renal failure, liver failure, [[pulmonary hypertension]], [[GI bleed]]s and rarely CNS symptoms
+
**[[Fever]], [[abdominal pain]], [[fatigue]], [[cough]], [[diarrhea]], [[eosinophilia]]
***Mostly through fibrosis of affected organs
+
**Lasts 4-8 weeks
**Genitourinary schistosomiasis
 
***Caused by sores in the genital tract
 
***May persist even after treatment
 
***Greatly increases risk of [[HIV]] infection
 
  
*Acute presentations
+
===Chronic (mostly a chronic condition)===
**Cutaneous rash/itching from cercariae penetration (immediate)
+
*Second most common cause of [[esophageal varices]] worldwide
**Katayama fever-Fever, Abdominal pain, Fatigue, Cough, Diarrhea, Eosinophilia (lasts 4-8 weeks)
+
*Greatly elevated bladder cancer rates in endemic areas
 +
*Can cause [[renal failure]], [[liver failure]], [[pulmonary hypertension]], [[GI bleed]]s and rarely CNS symptoms
 +
**Mostly through fibrosis of affected organs
 +
*Genitourinary schistosomiasis
 +
**Caused by sores in the genital tract
 +
**May persist even after treatment
 +
**Greatly increases risk of [[HIV]] infection
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==
 
*[[UTI]]
 
*[[UTI]]
 
*[[STD]]
 
*[[STD]]
*Intestional parasites
+
*Intestinal [[parasites]]
 
*[[Traveler's diarrhea]]
 
*[[Traveler's diarrhea]]
  
 
==Evaluation==
 
==Evaluation==
 +
[[File:Schistosomiaisis Bladder Calcifications.png|thumb|Calcifications on bladder wall caused by urinary schistosomiasis]]
 +
[[File:PMC4891583 gr3d.png|thumb|CT of hepatosplenic S. mansoni infection illustrating irregular liver surface and periportal fibrosis and enhancement of portal venous structures surrounded by inner ring of hypoattenuation and outer ring of enhancement (arrows). Hypoattenuated ring presumably represents areas of periportal fibrosis with decreased vascularity, whereas enhancing rim may be due to periportal inflammation. These concentric rings correspond to the “bull's eye” appearance of periportal fibrosis previously described with ultrasound.]]
 +
 
===Work-up===
 
===Work-up===
**ELISA
+
*ELISA
**PCR from stool or urine
+
*PCR from stool or urine
**Stool and Urine for ova/parasites
+
*Stool and Urine for ova/parasites
***biopsy may be needed for those who do not show ova/parasites in stool/urine
+
**biopsy may be needed for those who do not show ova/parasites in stool/urine
**CBC, Alk Phos, GGT, ALT/AST, Cr, Blood cultures
+
*CBC, [[LFTs]], BMP, blood cultures
**Consider [[ultrasound]] for hepatosplenic (periportal fibrosis) or urinary disease (hydro)
+
*Consider [[ultrasound]] for hepatosplenic (periportal fibrosis) or urinary disease (hydro)
**Echo and CXR for pulmonary hypertension and/or cor pulmonale
+
*[[Echocardiography]] and [[CXR]] for pulmonary hypertension and/or cor pulmonale
**Consider CT or MRI for CNS disease or further workup of periportal fibrosis
+
*Consider [[head CT|CT]] or [[brain MRI|MRI]] for CNS disease or further workup of periportal fibrosis
 
 
===Evaluation===
 
 
 
  
 
==Management==
 
==Management==
*Praziquantel 20mg/kg PO for two doses in 1 day <ref>CDC. Schistosomiasis. http://www.cdc.gov/parasites/schistosomiasis/health_professionals/index.html</ref>
+
*[[Praziquantel]] 20mg/kg PO for two doses in 1 day <ref>CDC. Schistosomiasis. http://www.cdc.gov/parasites/schistosomiasis/health_professionals/index.html</ref>
 
**S.japnonicum requires 3 doses in 1 day
 
**S.japnonicum requires 3 doses in 1 day
  
 
==Disposition==
 
==Disposition==
 +
*Generally may be discharged
 +
*Admit if concern for CNS infection
  
 
==See Also==
 
==See Also==
*[[Parasitic infections]]
+
*[[Parasitic infection]]
  
 
==External Links==
 
==External Links==
 +
  
 
==References==
 
==References==

Latest revision as of 12:52, 2 May 2020

Background

  • Caused by parasitic trematodes of the species Schistosoma
  • Reservoir is freshwater snails
  • Endemic in areas of Africa and Southern Asia
  • The Cercariae (the stage of trematode released by the snail) can infect by direct penetration through the skin
  • Infects >200million people worldwide with 10% suffering severe consequences

Clinical Features

Acute

Chronic (mostly a chronic condition)

  • Second most common cause of esophageal varices worldwide
  • Greatly elevated bladder cancer rates in endemic areas
  • Can cause renal failure, liver failure, pulmonary hypertension, GI bleeds and rarely CNS symptoms
    • Mostly through fibrosis of affected organs
  • Genitourinary schistosomiasis
    • Caused by sores in the genital tract
    • May persist even after treatment
    • Greatly increases risk of HIV infection

Differential Diagnosis

Evaluation

Calcifications on bladder wall caused by urinary schistosomiasis
CT of hepatosplenic S. mansoni infection illustrating irregular liver surface and periportal fibrosis and enhancement of portal venous structures surrounded by inner ring of hypoattenuation and outer ring of enhancement (arrows). Hypoattenuated ring presumably represents areas of periportal fibrosis with decreased vascularity, whereas enhancing rim may be due to periportal inflammation. These concentric rings correspond to the “bull's eye” appearance of periportal fibrosis previously described with ultrasound.

Work-up

  • ELISA
  • PCR from stool or urine
  • Stool and Urine for ova/parasites
    • biopsy may be needed for those who do not show ova/parasites in stool/urine
  • CBC, LFTs, BMP, blood cultures
  • Consider ultrasound for hepatosplenic (periportal fibrosis) or urinary disease (hydro)
  • Echocardiography and CXR for pulmonary hypertension and/or cor pulmonale
  • Consider CT or MRI for CNS disease or further workup of periportal fibrosis

Management

  • Praziquantel 20mg/kg PO for two doses in 1 day [1]
    • S.japnonicum requires 3 doses in 1 day

Disposition

  • Generally may be discharged
  • Admit if concern for CNS infection

See Also

External Links

References